Spinal cord infarction

OVERVIEW

Spinal cord infarction is necrosis of a portion of the spinal cord as a result of an interruption of the blood supply to the spine

RISK FACTORS

  • female sex
  • atrial fibrillation with no anticoagulation
  • hypertension
  • hypercholesterolemia
  • type II diabetes
  • smoking
  • hypercoagulable states

ASSESSMENT

History

  • Acute tetraparesis or paraparesis with a sensory level corresponding with level of cord infarct
  • No historical suspicion of trauma or infection
  • 60 % of patients present with pain that localizes to the level of injury
  • May be associated with aortic surgery or procedures such as celiac ganglion ablation
  • Risk factors may be present

Examination

  • Anterior spinal artery syndrome is most common: loss of motor function and pain/temperature sensation, with relative sparing of proprioception and vibratory sense below the level of lesion
  • Initially presents with a flaccid paralysis and loss of deep tendon reflexes
  • Usually bilateral weakness, occasionally unilateral
  • Posterior spinal artery syndrome: loss of proprioception and vibratory sense below the level of the injury and total anesthesia at the level of injury; weakness usually mild/transient
  • Other variants possible

Investigations

  • MRI is diagnostic, showing an ischemic lesion defined as a well-demarcated T2-weighted hyperintensity matching an arterial territory of the cord
  • Spinal angiogram recommended if vascular malformation suggested from MRI

MANAGEMENT

  • Resuscitation to address immediate life threats
  • Supportive care and monitoring
  • Corticosteroids are not currently recommended
  • Anti-platelet agents may be used if coexistent vascular risk factors/ comorbidities are present,to reduce the risk of further atherothrombotic/ embolic events

References and Links

Journal articles

  • Flower O, Bowles C, Wijdicks E, Weingart SD, Smith WS. Emergency neurological life support: acute non-traumatic weakness. Neurocrit Care. 2012 Sep;17 Suppl 1:S79-95. PMID: 22972018.
  • Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Archives of neurology. 63(8):1113-20. 2006 [PMID 16908737]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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